Provider Demographics
NPI:1396058301
Name:ANGELS ARM HOME HEALTHCARE
Entity type:Organization
Organization Name:ANGELS ARM HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DAISY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-943-2188
Mailing Address - Street 1:119 PATRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:VARNVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29944
Mailing Address - Country:US
Mailing Address - Phone:803-943-2188
Mailing Address - Fax:
Practice Address - Street 1:119 PATRIDGE LN
Practice Address - Street 2:
Practice Address - City:VARNVILLE
Practice Address - State:SC
Practice Address - Zip Code:29944
Practice Address - Country:US
Practice Address - Phone:803-943-2188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC347C00000X
251E00000X, 253Z00000X, 305R00000X, 305S00000X, 310400000X, 343900000X, 302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
No347C00000XTransportation ServicesPrivate Vehicle
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)